Provider Demographics
NPI:1104061407
Name:KENI, JYOTSNA (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTSNA
Middle Name:
Last Name:KENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4008
Mailing Address - Country:US
Mailing Address - Phone:714-432-1950
Mailing Address - Fax:
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4008
Practice Address - Country:US
Practice Address - Phone:714-432-1950
Practice Address - Fax:714-432-1953
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98869208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA98869OtherMEDICAL LICENSE NUMBER
CAA98869OtherMEDICAL LICENSE NUMBER